An End-User Evaluation of Blast Overpressure and Accelerative Impact Body-Worn Sensors.

INTRODUCTION: Blast overpressure and accelerative impact can produce concussive-like symptoms in service members serving both garrison and deployed environments. In an effort to measure, document, and improve the response to these overpressure and impact events, the U.S. Army Medical Material Development Activity is evaluating body-worn sensors for use by the Joint Conventional Force. In support, the WRAIR completed a qualitative end-user evaluation with service members from high-risk mission occupational specialties to determine the potential needs, benefits, and challenges associated with adopting body-worn sensors into their job duties. MATERIALS AND METHODS: WRAIR staff led hour-long semi-structured focus groups with 156 Army, Navy, and Marine Corps participants, primarily representing infantry, combat engineer, explosive ordnance disposal, artillery, mortar, and armor job specialties. Topics included their sensor needs, concepts of operations, and recommended design features for implementing sensors into the force. Dialogue from each focus group was audio recorded and resulting transcripts were coded for thematic qualitative analysis using NVivo software. RESULTS: Users recommended a single, unobtrusive, rugged, multi-directional sensor that could be securely mounted to the helmet and powered by a battery type (such as rechargeable lithium or disposable alkaline batteries) that was best suited for their garrison and field/deployed environments. The sensors should accurately measure low-level (∼1.0 pounds per square inch) blasts and maintain a record of cumulative exposures for each service member. Discussions supported the need for immediate, actionable feedback from the sensor with the option to view detailed blast or impact data on a computer. There were, however, divergent opinions on security issues regarding wireless versus wired data transfer methods. Participants also expressed a need for the exposure data to integrate with their medical records and were also willing to have their data shared with leadership, although opinions differed on the level of echelon and if the data should be identifiable. Regarding accountability, users did not want to be held fiscally liable for the sensors and recommended having the unit be responsible for maintenance and distribution. Concerns about being held fiscally liable, being overly burdened, and having one's career negatively impacted were listed as factors that could decrease usage. Finally, participants highlighted the importance of understanding the purpose and function of the sensors and supported a corresponding training module. CONCLUSIONS: Participating service members were generally willing to adopt body-worn sensors into their garrison and deployed activities. To maximize adoption of the devices, they should be convenient to use and should not interfere with service members' job tasks. Providing a clear understanding of the benefits (such as incorporating exposure data into medical records) and the function of sensors will be critical for encouraging buy-in among users and leaders. Incorporating end-user requirements and considering the benefits and challenges highlighted by end users are important for the design and implementation of body-worn sensors to mitigate the risks of blast overpressure and accelerative impact on service members' health.

Impact of mindfulness training and yoga on injury and pain-related impairment: a group randomized trial in basic combat training.

Introduction: Service members are at risk for pain-related difficulties in functioning and physical injury. Previous studies suggest that mindfulness training (MT) and yoga may prevent these outcomes. The present study was designed to determine the impact of MT and yoga on the health, pain, and injury of Army trainees completing 10 weeks of basic combat training (BCT). Methods: Platoons (≈40 trainees per platoon) were randomized to MT and yoga or training-as-usual in October to December 2020 at a large installation in the US. Self-reported outcomes were health, pain level, and pain impact on training, sleep, mood, and stress. Objective outcomes were injury-related medical encounters and number of diagnoses. The trial was registered at ClinicalTrials. Gov (NCT05550610). Results: Intervention trainees reported significantly better health (OR = 1.05, 95% CI [1.00, 1.10]) and less impact of pain on training (OR = 0.81, 95% CI [0.74, 0.90]), sleep (OR = 0.88, 95% CI [0.81, 0.95]), mood (OR = 0.86, 95% CI [0.78, 0.96]), and stress (OR = 0.88, 95% CI [0.79, 0.98]). There was no significant difference in injury-related medical encounters (AOR = 0.70, 95% CI [0.48, 1.03]), but intervention trainees had fewer diagnoses (OR = 0.67, 95% CI [0.47, 0.95]) and were 30% less likely to have a first medical encounter at any time during BCT. This difference emerged 3 weeks into BCT. Discussion: A combined MT and yoga intervention resulted in better trainee health. The US Army and other organizations requiring resilience under extreme stress should consider implementing MT and yoga to offset risks to employee health.

Short-term neurochemical effects of transcutaneous trigeminal nerve stimulation using 7T magnetic resonance spectroscopy.

BACKGROUND AND PURPOSE: The purpose was to explore the effects of transcutaneous trigeminal nerve stimulation (TNS) on neurochemical concentrations (brainstem, anterior cingulate cortex [ACC], dorsolateral prefrontal cortex [DLPFC], ventromedial prefrontal cortex [VMPFC], and the posterior cingulate cortex [PCC]) using ultrahigh-field magnetic resonance spectroscopy. METHODS: This double-blinded study tested 32 healthy males (age: 25.4 ± 7.3 years) on two separate occasions where participants received either a 20-minute TNS or sham session. Participants were scanned at baseline and twice post-TNS/sham administration. RESULTS: There were no group differences in concentration changes of glutamate, gamma-aminobutyric acid, glutamine, myoinositol (mI), total N-acetylaspartate, total creatine (tCr), and total choline between the baseline scan and the first post-TNS/sham scan and between the first and second post-TNS/sham scan in the brainstem, ACC, DLPFC, VMPFC, and PCC. Between the baseline scan and the second post-TNS/sham scan, changes in tCr (mean difference = 0.280 mM [0.075 to 0.485], p = .026) and mI (mean difference = 0.662 mM [0.203 to 1.122], p = .026) in the DLPFC differed between groups. Post hoc analyses indicated that there was a decrease in tCr (mean change = -0.201 mM [-0.335 to -0.067], p = .003) and no change in mI (mean change = -0.327 mM [-0.737 to 0.083], p = .118) in the TNS group; conversely, there was no change in tCr (mean change = -0.100 mM [-0.074 to 0.274], p = .259) and an increase in mI (mean change = 0.347 mM [0.106 to 0.588], p = .005) in the sham group. CONCLUSION: These data demonstrate that a single session of unilateral TNS slightly decreased tCr concentrations in the DLPFC region.

Sleep restriction and cognitive load affect performance on a simulated marksmanship task.

Sleep restriction degrades cognitive and motor performance, which can adversely impact job performance and increase the risk of accidents. Military personnel are prone to operating under sleep restriction, and previous work suggests that military marksmanship may be negatively affected under such conditions. Results of these studies, however, are mixed and have often incorporated additional stressors (e.g. energy restriction) beyond sleep restriction. Moreover, few studies have investigated how the degree of difficulty of a marksmanship task impacts performance following sleep restriction. The purpose of the current experiment was to study the effects of sleep restriction on marksmanship while minimizing the potential influence of other forms of stress. A friend-foe discrimination challenge with greater or lesser degrees of complexity (high versus low load) was used as the primary marksmanship task. Active duty Soldiers were recruited, and allowed 2 h of sleep every 24 h over a 72-h testing period. Marksmanship tasks, cognitive assessment metrics and the NASA-Task Load Index were administered daily. Results indicated that reaction times to shoot foe targets and signal friendly targets slowed over time. In addition, the ability to correctly discriminate between friend and foe targets significantly decreased in the high-cognitive-load condition over time despite shot accuracy remaining stable. The NASA-Task Load Index revealed that, although marksmanship performance degraded, participants believed their performance did not change over time. These results further characterize the consequences of sleep restriction on marksmanship performance and the perception of performance, and reinforce the importance of adequate sleep among service members when feasible.

Impact of sleep restriction on local immune response and skin barrier restoration with and without "multinutrient" nutrition intervention.

Systemic immune function is impaired by sleep restriction. However, the impact of sleep restriction on local immune responses and to what extent any impairment can be mitigated by nutritional supplementation is unknown. We assessed the effect of 72-h sleep restriction (2-h nightly sleep) on local immune function and skin barrier restoration of an experimental wound, and determined the influence of habitual protein intake (1.5 g·kg-1·day-1) supplemented with arginine, glutamine, zinc sulfate, vitamin C, vitamin D3, and omega-3 fatty acids compared with lower protein intake (0.8 g·kg-1·day-1) without supplemental nutrients on these outcomes. Wounds were created in healthy adults by removing the top layer of less than or equal to eight forearm blisters induced via suction, after adequate sleep (AS) or 48 h of a 72-h sleep restriction period (SR; 2-h nightly sleep). A subset of participants undergoing sleep restriction received supplemental nutrients during and after sleep restriction (SR+). Wound fluid was serially sampled 48 h postblistering to assess local cytokine responses. The IL-8 response of wound fluid was higher for AS compared with SR [area-under-the-curve (log10), 5.1 ± 0.2 and 4.9 ± 0.2 pg/ml, respectively; P = 0.03]; and both IL-6 and IL-8 concentrations were higher for SR+ compared with SR ( P < 0.0001), suggestive of a potentially enhanced early wound healing response. Skin barrier recovery was shorter for AS (4.2 ± 0.9 days) compared with SR (5.0 ± 0.9 days) ( P = 0.02) but did not differ between SR and SR+ ( P = 0.18). Relatively modest sleep disruption delays wound healing. Supplemental nutrition may mitigate some decrements in local immune responses, without detectable effects on wound healing rate. NEW & NOTEWORTHY The data herein characterizes immune function in response to sleep restriction in healthy volunteers with and without nutrition supplementation. We used a unique skin wound model to show that sleep restriction delays skin barrier recovery, and nutrition supplementation attenuates decrements in local immune responses produced by sleep restriction. These findings support the beneficial effects of adequate sleep on immune function. Additional studies are necessary to characterize practical implications for populations where sleep restriction is unavoidable.

The synthetic neuroactive steroid SGE-516 reduces status epilepticus and neuronal cell death in a rat model of soman intoxication.

Organophosphorus nerve agents (OPNAs) are irreversible inhibitors of acetylcholinesterase that pose a serious threat to public health because of their use as chemical weapons. Exposure to high doses of OPNAs can dramatically potentiate cholinergic synaptic activity and cause status epilepticus (SE). Current standard of care for OPNA exposure involves treatment with cholinergic antagonists, oxime cholinesterase reactivators, and benzodiazepines. However, data from pre-clinical models suggest that OPNA-induced SE rapidly becomes refractory to benzodiazepines. Neuroactive steroids (NAS), such as allopregnanolone, retain anticonvulsant activity in rodent models of benzodiazepine-resistant SE, perhaps because they modulate a broader variety of GABAA receptor subtypes. SGE-516 is a novel, next generation NAS and a potent and selective GABAA receptor positive allosteric modulator (PAM). The present study first established that SGE-516 reduced electrographic seizures in the rat lithium-pilocarpine model of pharmacoresistant SE. Then the anticonvulsant activity of SGE-516 was investigated in the soman-intoxication model of OPNA-induced SE. SGE-516 (5.6, 7.5, and 10mg/kg, IP) significantly reduced electrographic seizure activity compared to control when administered 20min after SE onset. When 10mg/kg SGE-516 was administered 40min after SE onset, seizure activity was still significantly reduced compared to control. In addition, all cohorts of rats treated with SGE-516 exhibited significantly reduced neuronal cell death as measured by FluoroJade B immunohistochemistry. These data suggest synthetic NASs that positively modulate both synaptic and extrasynaptic GABAA receptors may be candidates for further study in the treatment of OPNA-induced SE.

Correction to Smith et al. (2013).

Reports an error in "Noradrenergic alpha-2 receptor modulators in the ventral bed nucleus of the stria terminalis: Effects on anxiety behavior in postpartum and virgin female rats" by Carl D. Smith, Christopher C. Piasecki, Marcus Weera, Joshua Olszewicz and Joseph S. Lonstein (Behavioral Neuroscience, 2013[Aug], Vol 127[4], 582-597). Table 2 should have used the ratio of 5HIAA/serotonin - rather than the inverse - as the indicator of serotonin turnover. Using the correct ratio, differences in serotonin turnover between the postpartum and virgin females are: BSTv - 1.11 0.06 vs 0.79 0.11 (t 2.57, p 0.05); BSTd - 1.01 0.07 vs 0.68 0.11 (t 2.58, p 0.05). That is, contrary to what was originally reported, postpartum females had higher serotonin turnover in both subregions of the BST compared to virgins. The penultimate sentence in the abstract noting serotonin turnover in mothers has been corrected in the online version of this article. (The following abstract of the original article appeared in record 2013-22430-001.) Emotional hyperreactivity can inhibit maternal responsiveness in female rats and other animals. Maternal behavior in postpartum rats is disrupted by increasing norepinephrine release in the ventral bed nucleus of the stria terminalis (BSTv) with the α2-autoreceptor antagonist, yohimbine, or the more selective α2-autoreceptor antagonist, idazoxan (Smith et al., 2012). Because high noradrenergic activity in the BSTv can also increase anxiety-related behaviors, increased anxiety may underlie the disrupted mothering of dams given yohimbine or idazoxan. To assess this possibility, anxiety-related behaviors in an elevated plus maze were assessed in postpartum rats after administration of yohimbine or idazoxan. It was further assessed if the α2-autoreceptor agonist clonidine (which decreases norepinephrine release) would, conversely, reduce dams' anxiety. Groups of diestrous virgins were also examined. It was found that peripheral or intra-BSTv yohimbine did increase anxiety-related behavior in postpartum females. However, BSTv infusion of idazoxan did not reproduce yohimbine's anxiogenic effects and anxiety was not reduced by peripheral or intra-BSTv clonidine. Because yohimbine is a weak 5HT1A receptor agonist, other groups of females received BSTv infusion of the 5HT1A receptor agonist 8OH-DPAT, but it did not alter their anxiety-related behavior. Lastly, levels of norepinephrine and serotonin in tissue punches from the BSTv did not differ between postpartum and diestrous rats, but serotonin turnover was higher in mothers. These results suggest that the impaired maternal behavior after BSTv infusion of yohimbine or idazoxan cannot both be readily explained by an increase in dams' anxiety, and that BSTv α2-autoreceptor modulation alone has little influence on anxiety-related behaviors in postpartum or diestrous rats.

Hormone-dependence of sarin lethality in rats: Sex differences and stage of the estrous cycle.

Chemical warfare nerve agents (CWNAs) are highly toxic compounds that cause a cascade of symptoms and death, if exposed casualties are left untreated. Numerous rodent models have investigated the toxicity and mechanisms of toxicity of CWNAs, but most are limited to male subjects. Given the profound physiological effects of circulating gonadal hormones in female rodents, it is possible that the daily cyclical fluctuations of these hormones affect females' sensitivity to the lethal effects of CWNAs, and previous reports that included female subjects did not control for the stage of the hormonal cycle. The aim of the current study was to determine the 24-hour median lethal dose (LD50) of the CWNA sarin in male, ovariectomized (OVEX) female, and female rats during different stages of the estrous cycle (diestrus, proestrus, and estrus). Additionally, baseline activity levels of plasma acetylcholinesterase, butyrylcholinesterase, and carboxylesterase were measured to determine differences among the groups. Results indicated that females in proestrus had a significantly higher LD50 of sarin compared to OVEX and estrous females. Although some sex differences were observed in the activity levels of plasma esterases, they were not consistent and likely not large enough to significantly affect the LD50s. These results suggest that hormonal cyclicity can influence the outcome of CWNA-related studies using female rodents, and that this variability can be minimized by controlling for the stage of the cycle. Additional research is necessary to determine the precise mechanism of the observed differences because it is unlikely to be solely explained by plasma esterase activity.

Noradrenergic alpha-2 receptor modulators in the ventral bed nucleus of the stria terminalis: effects on anxiety behavior in postpartum and virgin female rats.

Emotional hyperreactivity can inhibit maternal responsiveness in female rats and other animals. Maternal behavior in postpartum rats is disrupted by increasing norepinephrine release in the ventral bed nucleus of the stria terminalis (BSTv) with the α2-autoreceptor antagonist, yohimbine, or the more selective α2-autoreceptor antagonist, idazoxan (Smith et al., 2012). Because high noradrenergic activity in the BSTv can also increase anxiety-related behaviors, increased anxiety may underlie the disrupted mothering of dams given yohimbine or idazoxan. To assess this possibility, anxiety-related behaviors in an elevated plus maze were assessed in postpartum rats after administration of yohimbine or idazoxan. It was further assessed if the α2-autoreceptor agonist clonidine (which decreases norepinephrine release) would, conversely, reduce dams' anxiety. Groups of diestrous virgins were also examined. It was found that peripheral or intra-BSTv yohimbine did increase anxiety-related behavior in postpartum females. However, BSTv infusion of idazoxan did not reproduce yohimbine's anxiogenic effects and anxiety was not reduced by peripheral or intra-BSTv clonidine. Because yohimbine is a weak 5HT1A receptor agonist, other groups of females received BSTv infusion of the 5HT1A receptor agonist 8OH-DPAT, but it did not alter their anxiety-related behavior. Lastly, levels of norepinephrine and serotonin in tissue punches from the BSTv did not differ between postpartum and diestrous rats, but serotonin turnover was lower in mothers. These results suggest that the impaired maternal behavior after BSTv infusion of yohimbine or idazoxan cannot both be readily explained by an increase in dams' anxiety, and that BSTv α2-autoreceptor modulation alone has little influence on anxiety-related behaviors in postpartum or diestrous rats.

Effects of noradrenergic alpha-2 receptor antagonism or noradrenergic lesions in the ventral bed nucleus of the stria terminalis and medial preoptic area on maternal care in female rats.

RATIONALE: Maternal behavior in laboratory rats requires a network of brain structures including the ventral bed nucleus of the stria terminalis (BSTv) and medial preoptic area (mPOA). Neurotransmitter systems in the BSTv and mPOA influencing maternal behaviors are not well understood, although norepinephrine is an excellent candidate because the BSTv contains the densest noradrenergic fiber plexus in the forebrain and norepinephrine in the mPOA is known to influence other female reproductive functions. OBJECTIVES: We hypothesized that downregulated noradrenergic activity in the BSTv and mPOA is necessary for mothering. METHODS: Postpartum mother-litter interactions were observed after BSTv infusion of yohimbine (an α2 autoreceptor antagonist that increases norepinephrine release), and after BSTv or mPOA infusion of the more selective α2 autoreceptor antagonist idazoxan. Lastly, noradrenergic input to the BSTv/mPOA was selectively lesioned in nulliparous rats with anti-DBH-saporin to determine if this would facilitate mothering. RESULTS: BSTv yohimbine almost abolished retrieval of pups but did not significantly affect dams' ability to initiate contact, lick, or nurse them. BSTv idazoxan disrupted retrieval somewhat less than yohimbine, but significantly reduced nursing. mPOA idazoxan impaired retrieval more severely than that found after BSTv infusion. Anti-DBH-saporin almost eliminated noradrenergic terminals in the BSTv and reduced them by over 60% in the mPOA, but did not promote maternal responding. It also did not affect females' anxiety-related behavior. CONCLUSIONS: Downregulated noradrenergic activity in the BSTv and mPOA is necessary for postpartum maternal behavior in rats, but eliminating this system alone is insufficient to promote maternal behaviors in nulliparous females.

Contact with infants modulates anxiety-generated c-fos activity in the brains of postpartum rats.

The postpartum period is associated with many behavioral changes, including a reduction in anxiety, which is thought to be necessary for mothers' ability to appropriately care for infants. In laboratory rats, this reduction in anxiety requires recent contact with pups, but areas of the brain where infant contact influences neural activity to reduce anxiety are mostly unknown. We examined c-fos expression in lactating rats whose pups were removed for 4h to increase mothers' anxiety, or not removed to maintain low anxiety in mothers, followed by exposure to the anxiogenic stimuli of either brief handling or handling followed by exposure to an elevated plus maze. Control animals had their litters removed or not, but no further stimulation. A large number of neural sites traditionally implicated in regulating anxiety in male rats were examined, and similar to what is found in male rats, most showed increased Fos expression after handling and/or elevated plus-maze exposure. Litter presence before testing affected Fos expression due to handling or elevated plus-maze exposure only in the ventral bed nucleus of the stria terminalis, dorsal and ventral preoptic area, ventromedial hypothalamus, lateral habenula, and supramammillary nucleus. Contrary to expectations, prior litter presence was associated with more Fos expression in most of these sites after handling and/or elevated plus-maze stimulation, and only after such stimulation. These sites may be of particular importance for how sensory inputs from infants modulate anxiety and other mood states during the postpartum period.

Medial preoptic area interactions with the nucleus accumbens-ventral pallidum circuit and maternal behavior in rats.

Several experiments explored the roles of nucleus accumbens (NA), ventral pallidum (VP) and medial preoptic area (MPOA) in the regulation of maternal behavior in rats. A preliminary experiment found that bilateral radiofrequency lesions of medial NA did not disrupt maternal behavior. Experiment 1 found that bilateral infusions of muscimol into VP, but not into medial NA, reversibly disrupted maternal behavior. Experiment 2 found that unilateral muscimol injections into VP disrupted maternal behavior to a greater extent when paired with a contralateral N-methyl-d-aspartic acid (NMDA) MPOA lesion than when paired with a sham MPOA lesion. Experiment 3 showed that a unilateral NMDA MPOA lesion paired with a contralateral NMDA VP lesion (Contra group) disrupted maternal behavior to a much greater extent than did sham NMLA lesions or NMDA lesions of MPOA and VP ipsilateral to one another. Experiment 3 focused on the specificity of the maternal behavior disruptions and found that the primary maternal deficit in the Contra females was a severe deficit in retrieval behavior. Importantly, these females showed normal hoarding behavior, home cage activity, and elevated plus maze activity. Experiment 3 used Neu N immunohistochemistry to define the extent of MPOA and VP excitotoxic lesions. It is hypothesized that MPOA acts to facilitate the active components of maternal behavior by inhibiting NA, which then releases VP from GABAergic inhibition, and such disinhibition of VP allows pup stimuli to trigger appropriate maternal responses.

The effects of D1 or D2 dopamine receptor antagonism in the medial preoptic area, ventral pallidum, or nucleus accumbens on the maternal retrieval response and other aspects of maternal behavior in rats.

The medial preoptic area (MPOA), ventral pallidum (VP), and nucleus accumbens (NA) receive dopaminergic afferents and are involved in maternal behavior. Experiments investigated whether dopamine (DA) receptor antagonism in NA disrupts maternal behavior, determined the type of DA receptor involved, and investigated the involvement of drug spread to VP or MPOA. Injection of SCH 23390 (D1 DA receptor antagonist) into NA of postpartum rats disrupted retrieving at dosage levels that were ineffective when injected into MPOA or VP. Motor impairment was not the cause of the deficit. Injection of eticlopride (D2 DA receptor antagonist) into NA or VP was without effect. Results emphasize the importance of DA action on D1 receptors in NA for retrieval behavior.